Provider Demographics
NPI:1578966636
Name:DEGEORGE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:DEGEORGE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-347-7469
Mailing Address - Street 1:1600 SAINT GEORGES AVE
Mailing Address - Street 2:STE 116
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-2764
Mailing Address - Country:US
Mailing Address - Phone:732-428-5566
Mailing Address - Fax:732-428-5513
Practice Address - Street 1:1600 SAINT GEORGES AVE
Practice Address - Street 2:STE 116
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-2764
Practice Address - Country:US
Practice Address - Phone:732-428-5566
Practice Address - Fax:732-428-5513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04134261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center